Originally published on Sept. 30, 2018.


One of the skills that babies need to develop is their suck-swallow-breathe co-ordination. This skill is something that develops with maturity, and not practise, which is one reason why we have to chosoe our starting point for oral feeding very carefully.

Sometimes at the beginning of oral feeding, babies need some outside help to manage the co-ordination of these skills. This is particularly true of bottle-fed babies. When babies exert pressure on a bottle teat, milk comes out. At the beginning of a breastfeed, it takes time for milk to flow. To an extent, the breast and baby adapt to each other in ways that the bottle does not. So we need to step in and make sure that we are doing this job for the bottle-fed baby.

Sometimes, babies start to suck and cannot stop. They suck and swallow, suck and swallow, but they don’t stop to breathe. At some point the brain recognises this as an emergency situation and they will breathe in. In the meantime, their oxygenation levels have dropped, and their body will repond as if to an emergency. Monitors will go off, and all-in-all this is a very stressful experience. In addition, if they breathe in with milk in their mouth, then they may aspirate milk (breathe milk into their lungs).

We want to avoid this situation if at all possible. Remember, finishing the bottle at this stage is not the aim, developing skills at the appropriate rate for the baby is.

Some babies find co-ordination difficult through the whole feed, but most commonly, it is the beginning part of the feed that is the issue, where the baby is most hungry and least able to regulate the amount of flow coming from the bottle well.

External pacing is a strategy that helps us manage this situation. It involves counting a set number of sucks (I often start with three), and then dropping the bottle teat beneath the level of the baby’s mouth. They may keep sucking for a little while, but usually they are prompted to stop sucking and breathe. After a few minutes of this, you can experiment with giving your baby back a little more control of the co-ordination experience. You will probably find, as the baby gets more experience, that you are having to pace them for less and less of the feed, as they mature in this skill.

If your baby is just not stopping sucking, you can actively break their suction on the teat by rolling the teat to the side of the mouth, or even removing the bottle. This is the least preferred option as it is likely to frustrate the baby who is probably really hungry, and they will have to organise themselves onto the teat all over again.

You can combine strategies to support your baby, for example, pacing and positioning, as discussed in a previous post.

Posts from Find the Key Speech Therapy are intended for information. They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child. Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance.